•Depression is more prevalent among adolescents with cannabis use compared to never users.•Among cannabis users, higher frequency of use was associated with lower rates of depression.•Consistent with ...prior research, female sex, past year alcohol use, and illicit drug use other than cannabis were associated with depression.
Cannabis use and major depressive disorder (MDD) are common and often co-morbid in adolescents, but the nature and directionality of the relationship between these two conditions remains obscure.
We examined results from the National Survey on Drug Use and Health. Weighted demographics were compared between adolescents with a history of cannabis use (N = 14,873) and never users (N = 73,079). Weighted logistic regression controlling for demographic variables and other substance use was used to determine the relationship between cannabis use frequency and MDD.
Adolescents with any history of cannabis use had significantly higher rates of lifetime and past year MDD, MDD with severe role impairment, and past year suicide attempt (p < 0.001). Comparing use frequency groups in the adjusted model revealed that heavy users (weekly or greater use) had significantly lower predicted prevalence of lifetime and past year MDD, and past year MDD with severe role impairment compared to light users and those who used cannabis >1 year ago. Rates of reported past year suicide attempt did not differ significantly by cannabis use frequency.
Adolescents with any cannabis use history have significantly higher rates of MDD. However, the directionality between frequency of use and MDD is counter to what was expected.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Since the introduction of Red Bull in Austria in 1987 and in the United States in 1997, the energy drink market has grown exponentially. Hundreds of different brands are now marketed, with ...caffeine content ranging from a modest 50 mg to an alarming 505 mg per can or bottle. Regulation of energy drinks, including content labeling and health warnings differs across countries, with some of the most lax regulatory requirements in the U.S. The absence of regulatory oversight has resulted in aggressive marketing of energy drinks, targeted primarily toward young males, for psychoactive, performance-enhancing and stimulant drug effects. There are increasing reports of caffeine intoxication from energy drinks, and it seems likely that problems with caffeine dependence and withdrawal will also increase. In children and adolescents who are not habitual caffeine users, vulnerability to caffeine intoxication may be markedly increased due to an absence of pharmacological tolerance. Genetic factors may also contribute to an individual's vulnerability to caffeine-related disorders including caffeine intoxication, dependence, and withdrawal. The combined use of caffeine and alcohol is increasing sharply, and studies suggest that such combined use may increase the rate of alcohol-related injury. Several studies suggest that energy drinks may serve as a gateway to other forms of drug dependence. Regulatory implications concerning labeling and advertising, and the clinical implications for children and adolescents are discussed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Opioid use disorder (OUD), also known as opioid dependence, opioid abuse, opioid misuse, opioid addiction, has been identified as a medical and social concern in the US for over 150 years, and while ...the extent of the problem has waxed and waned over time, recent years have been marked by a devastating and unremitting presence of this disorder. Attempts to address OUD and the high number of annual opioid overdose deaths as well as the impact of OUD on lives, families, and communities have been particularly challenging for providers and researchers, despite ongoing pharmacotherapy innovation, the expansion of treatment capacity, and social and professional efforts to curtail the availability of opioids (especially prescription opioids). Here, Bergeria and Strain aim to provide a summary of this disorder, highlighting current issues, what people know about the science and treatment, and ideas for addressing this disorder in a rapidly shifting setting.
•There was a recent surge in older adults seeking treatment for opioid use disorder.•Older adults seeking treatment for heroin use increased 110% between 2012–2015.•This population is increasingly ...female and African American.•Older adults are increasingly seeking treatment outside of urban areas.
Older adults with opioid use disorder (OUD) are a medically complex population. The current study evaluated trends in older adults seeking treatment for OUD, with a focus on primary heroin versus prescription opioid use. This study also compared older adults with OUD to the younger OUD population on demographics and drug use behaviors.
Publicly available data from state-certified addiction treatment centers were collected via the Treatment Episode Data Set – Admissions (TEDS-A) between 2004–2015. This study utilized Joinpoint Regression to conduct a cross-sectional, longitudinal analysis of trends in first-time treatment admissions for OUD in adults 55 and older (older adults; n = 400,421) versus adults under the age of 55 (n = 7,795,839). Given the rapid increase in older adults seeking treatment for OUD between 2013–2015, secondary outcomes include changes in demographics and drug use between 2012 (as a baseline year) and 2015.
The proportion of older adults seeking treatment for OUD rose steadily between 2004–2013 (41.2% increase; p-trend = 0.046), then rapidly between 2013–2015 (53.5% increase; p-trend = 0.009). The proportion of older adults with primary heroin use more than doubled between 2012–2015 (p < 0.001); these individuals were increasingly male (p < 0.001), African American (p < 0.001), and using via the intranasal route of administration (p < 0.001).
There has been a recent surge in older adults seeking treatment for OUD, particularly those with primary heroin use. Specialized treatment options for this population are critically needed, and capacity for tailored elder care OUD treatments will need to increase if these trends continue.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
•Many persons with opioid use disorder (OUD) are exposed to fentanyl daily.•Fentanyl clearance was examined in OUD patients in residential treatment.•Mean fentanyl clearance was 2 weeks, with a range ...of 4–26 days.•Protracted fentanyl clearance might affect withdrawal and medications for OUD.
The illicit opioid supply in the U.S. is increasingly adulterated with fentanyl. As such, persons with opioid use disorder (OUD) may be regularly exposed to fentanyl, however, the pharmacokinetics of repeated fentanyl exposure are not well understood. The current study aimed to quantify renal clearance of fentanyl in OUD patients presenting to residential treatment.
Participants (N = 12) who presented to a 28-day residential treatment program were enrolled if they tested positive for fentanyl at intake. Urine samples were collected every 2–3 days and were quantitatively tested for fentanyl, norfentanyl, and creatinine via liquid chromatography mass spectrometry (LC–MS). Fentanyl clearance was defined as the time since last illicit opioid use and the median time between last positive and first negative fentanyl urine screen.
Participants had a mean and standard deviation (SD) age of 28.9 (11.0), were 67 % male, and 83 % white. The mean (SD) time for fentanyl and norfentanyl clearance was 7.3 (4.9) and 13.3 (6.9) days, respectively. One participant continued to test positive for fentanyl for 19 days and norfentanyl for 26 days following their last use, and left treatment without testing negative for norfentanyl.
Fentanyl clearance in persons with OUD is considerably longer than the typical 2–4 day clearance of other short-acting opioids. The findings of this study might explain recent reports of difficulty in buprenorphine inductions for persons who use fentanyl, and point to a need to better understand the pharmacokinetics of fentanyl in the context of opioid withdrawal in persons who regularly use fentanyl.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Sustained abstinence is currently the only accepted end‐point for pharmacotherapy trials for most substance use disorders (SUD), with the exception of alcohol. Despite recent efforts, the ...identification of a non‐abstinence alternative as a clinically meaningful end‐point for drug use trials has been elusive.
Argument and analysis
The current standard for establishing a clinically meaningful outcome in SUD trials is to demonstrate that a reduction in drug use is associated with improvement in long‐term functioning, but data indicate relatively weak associations between drug use and various psychosocial problem domains. This may be because assessments used most commonly to measure an individual's functioning do not specify whether aspects of functioning are a direct consequence of drug use. The acceptance of a non‐abstinence‐based end‐point for alcohol use disorder trials was supported in part through associations with reductions in alcohol‐related consequences, although measures designed to assess the direct consequences of drug use are rarely included in drug treatment efficacy trials.
Conclusions
The field of substance use disorders should include measures of negative psychosocial and health consequences of drug use, as opposed to overall functioning, in the effort to establish meaningful non‐abstinence‐based end‐points.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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